Introduction and Objective: The impact of glycemic variability (GV) on muscle mass in Type 2 diabetes mellitus (T2DM) remains unclear under the updated Asian Working Group for Sarcopenia (AWGS) 2025 criteria. We investigated the association between continuous glucose monitoring (CGM)-derived GV and low skeletal muscle mass (LSMM).Methods: This cross-sectional study included 614 hospitalized T2DM patients aged ≥50 years. GV metrics (SD, MODD, LAGE, and CV) were derived from 7-day CGM data. LSMM was identified using bioelectrical impedance analysis based on age-specific AWGS 2025 thresholds. Multivariate logistic regression, restricted cubic splines (RCS), subgroup, and mediation analyses were performed.Results: Patients with LSMM (n=174, 28.3%) were predominantly male (70.1% vs. 50.5%, p<0.001) and had significantly lower BMI (21.0 vs. 24.4 kg/m ², p<0.001). Patients with LSMM exhibited significantly higher GV. In fully adjusted models, higher SD (OR = 1.36), MODD (OR = 1.38), and LAGE (OR = 1.08) were independently associated with increased LSMM risk (all p <0.05). RCS analysis revealed a linear dose-response relationship between GV and LSMM. Subgroup analyses demonstrated consistent associations across BMI, eGFR, sex, age and HbA1c categories (all p for interaction >0.05). Mediation analysis indicated that insulin resistance (HOMA2-IR) partially mediated the GV-LSMM relationship.Conclusion: Elevated GV is independently associated with LSMM in middle-aged and older adults with T2DM, showing a linear dose-response pattern consistent across diverse clinical profiles. Strategies targeting glucose fluctuations may be crucial for preserving muscle mass in this population.
Y. Huang: None. Y. Yang: None. H. Deng: None. B. Lin: None. J. Yan: None. X. Yang: None. W. Xu: None.
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